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Dr Basu, Experienced Specialist

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My husband has had severe abdominal pain for three months now.

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My husband has had severe abdominal pain for three months now. He had a complete CT scan which showed he is unremarkably well from top (the stomach) to bottom (the bowel). He had diverticulitis surgery Nov. 2012 which we are questioning now, because it is the exact same pain in the same location as then. There is no nausea, diarrhea, bleeding, acid reflux, nothing. He has been on Tramadol, Hyoscyamine and Dexilant to no avail, most likely because what the meds are for is not the issue. Now my family physician is suggesting a Laproscopic surgery or a pain clinic. NO. When I looked up ulcers, he has no stomach ulcer (per the CT) but I came across duodenal ulcers that describe his symptoms perfectly. Food helps the pain go away. He did take Advil meds for his back for a long time which ruins the lining of the small intestines. Maybe an endoscopy would see that. He is 67 and our diet is so bland. No fried foods. We even tried off wheat / gluten diet. We've been through the doctor mill. PLEASE, anything that you could suggest.

I am sorry to hear about the sufferings your husband has been going through. Although Ct scan is normal, this does not rule out ulcer disease completely. Duodenal ulcer is still a possibility. He is not responding to dexilant. Sometimes increased doses of PPi is necessary for ulcer treatment. Also H pylori bacterial infection can be coexistent in the ulcer. So, that also needs to be checked. He will need upper GI endoscopy definitely along with H pylori testing. There can be other possibilities as well:1. Non functioning gallbladder--if the gallbladder is not functioning well, that can cause pain--usually associated with meals though. A HIDA scan ( nuclear medicine scan) is better to assess gallbladder function. 2.Chronic mesenteric ischemia--this is due to the reduced blood circulation in the intestines causing intestinal angina. The pain is apparent within an hour of eating food but subsides after 2-3 hours. The diagnosis is made by the doppler ultrasound to detect the narrowing or blockage of the blood vessels. 3. Infiltrative granulomatous diseases--Sarcoidosis and Crohn's disease can sometimes affect the duodenum. This can be diagnosed by the upper GI endoscopy.

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